Blood pressure Edema Intake-Output Urine Blood Presence of

mmof Hg and examina- values alarming

body tion symptom
weight Proteinuria Once a
(Daily) (Daily) week
6am 12 6pm 10 Intake Out- Bala Haematocrit Headache
noon pm put nce Platelet Epigastric
Uric acid pain
Creatinine Visual
LFT disturbance

PROGRESS CHART
Name: Age Registration no Unit:

Address Date of admission:

LMP: EDD: Parity Gravida Period of gestation